Provider Demographics
NPI:1417350042
Name:GRAFE, KATHI (CNP)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:
Last Name:GRAFE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 TURTLE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2776
Mailing Address - Country:US
Mailing Address - Phone:508-759-7279
Mailing Address - Fax:508-888-7553
Practice Address - Street 1:16 WATERHOUSE RD
Practice Address - Street 2:
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-3897
Practice Address - Country:US
Practice Address - Phone:508-759-7279
Practice Address - Fax:508-888-7553
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN276765363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health